Provider Demographics
NPI:1669526794
Name:WALTER, JOHN CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHARLES
Last Name:WALTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 MEDICAL PL
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2639
Mailing Address - Country:US
Mailing Address - Phone:812-523-3020
Mailing Address - Fax:812-523-3421
Practice Address - Street 1:1131 MEDICAL PL
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2639
Practice Address - Country:US
Practice Address - Phone:812-523-3020
Practice Address - Fax:812-523-3421
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008280A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist